Young persons’ experiences of inpatient care when presenting with self-harm

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Young persons’ experiences of inpatient care when presenting with self-harm

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In the UK, self-harm is a major healthcare problem. Self-harm is an especially common behaviour in young people admitted to psychiatric inpatient care and is one of the primary reasons for presenting to hospital. The management and treatment of self-harming behaviours can be challenging, and few treatment guidelines are available for inpatient settings. Poor understanding of self-harm and how to manage it effectively is likely to lead to staff feeling hopeless and helpless, but also to reduced support for the young people under their care. The current study constitutes an attempt to build on what is known by exploring young people’s reports on their experiences of inpatient treatment when presenting with self-harm. A grounded theory methodology was used to analyse the data. There were two key study aims which were: to obtain young people’s reports on their experiences of inpatient care when presenting with self-harm; and to integrate these views into a grounded theory that would serve as a model for understanding features of young persons’ experiences of inpatient care when presenting with self-harm. Semi-structured interviews were conducted at two NHS inpatient units supporting young people with mental health difficulties. Analysis of these interviews was done in accordance with grounded theory. Two core concepts of humanness and restriction emerged from the data which contribute to the construction of meaning and understanding. Service implications and recommendations highlight the need for improved understanding, maintaining relationships and continued connection during admissions. The methodology contributed to developing a rich and detailed understanding of young persons’ experiences of inpatient care when presenting with self-harm.

In the UK, self-harm is a significant healthcare issue, particularly among young people admitted to psychiatric inpatient care (Majid et al., 2016). The Royal College of Psychiatrists (RCP) has noted an increase in the incidence of self-harm over the past 20 years, though these estimates likely underrepresent the true scope due to reliance on hospital admissions data (Holley et al., 2012). Self-harm is one of the primary reasons for hospital admissions among young people, making its management in inpatient settings particularly challenging (Ougrin et al., 2012; Hawton & Rodham, 2006).

Despite the prevalence of self-harm, there are few treatment guidelines available for inpatient settings, contributing to a poor understanding among healthcare staff regarding effective management strategies (Doyle et al., 2017). This lack of understanding can result in feelings of hopelessness and helplessness among staff, ultimately reducing the support available to young patients (Rouski, Hodge, & Tatum, 2017).

This study aimed to explore young people's experiences of inpatient care when presenting with self-harm, utilising grounded theory methodology to analyse the data. The primary objectives were to gather reports from young people about their inpatient experiences and to integrate these insights into a grounded theory model. This model sought to elucidate the factors influencing these experiences, providing a framework for understanding and improving care practices.

Semi-structured interviews were conducted with young people at two NHS inpatient units specialising in mental health care for adolescents. Analysis of the interview transcripts, conducted in line with grounded theory principles, revealed two core concepts: Humanness and Restriction. These concepts are integral to understanding the construction of meaning and the overall experience of inpatient care for young people who self-harm.

The findings highlight the need for enhanced understanding, sustained relationships, and continuous connection during hospital admissions. These insights are essential for developing effective treatment guidelines and improving clinical practice. This study contributes to a richer, more nuanced understanding of young people's experiences in psychiatric inpatient settings, particularly concerning self-harm.

2.1 Philosophy of the Approach

The philosophical foundation of this research is rooted in constructivist grounded theory, which aligns with the interpretivist paradigm. This paradigm emphasises understanding the complex world of lived experiences from the participants' perspectives (Charmaz, 2006). The research philosophy is shaped by ontological and epistemological positions that view reality as constructed through social interactions and knowledge as inherently linked to the knower's context and experiences (Guba & Lincoln, 1994; Schwandt, 1998).

2.2 Why Use a Qualitative Approach?

Qualitative methodologies, particularly grounded theory, are increasingly recognised for their ability to capture the depth and complexity of human experiences (Pope & Mays, 2006). This study employs a qualitative approach to explore the intricate dynamics of young people's experiences in inpatient settings when presenting with self-harm. A constructivist grounded theory methodology was chosen to develop a theoretical model grounded in the participants' perspectives, providing a nuanced understanding of their experiences (Charmaz, 2006).

2.3 Grounded Theory

2.3.1 Introduction to Grounded Theory

Grounded theory is a qualitative research method aimed at developing theories grounded in systematically collected and analysed data (Glaser & Strauss, 1967). This study employs Charmaz's constructivist grounded theory approach, which emphasises the co-construction of knowledge by the researcher and participants, acknowledging the researcher's influence on the research process (Charmaz, 2006). Unlike traditional or evolved grounded theory, which strive for researcher objectivity and minimal preconceptions, constructivist grounded theory embraces the researcher's active role in shaping the research outcomes (Ramalho et al., 2015).

2.3.2 How Grounded Theory is Used in This Study

The study began with a preliminary literature review to identify gaps and sensitise the researcher to relevant issues (Giles, King, & de Lacey, 2013). Data collection and analysis were conducted iteratively, allowing emerging categories to guide further data collection. This iterative process ensures that the theory developed is deeply rooted in the data (Charmaz, 2006). The researcher's engagement with the data and reflexive documentation of the research process enhances transparency and credibility (Pidgeon & Henwood, 1996).

2.3.3 The Motivation to Use Grounded Theory

Grounded theory is particularly suited to research areas where little is known about the phenomenon under investigation (Corbin & Strauss, 2008). Given the paucity of research on young people's experiences of inpatient care for self-harm, this methodology allows for a rich exploration of their perspectives, facilitating the development of a robust theoretical model. The study aimed to capture multiple perspectives to provide a comprehensive understanding of the factors influencing these experiences (Strauss & Corbin, 1997).

2.3.4 The Implementation of Grounded Theory

a) Data Collection

Data collection was conducted using semi-structured interviews, a flexible method that facilitates in-depth exploration of participants' experiences (Willig, 2008). Interviews were audio-recorded and transcribed verbatim to ensure the integrity of the data.

b) Open Coding and Categorisation

Initial data analysis involved open coding, which entails segmenting the data into meaningful units and labelling them to capture the detail and complexity of participants' experiences (Charmaz, 2006). This process formed the foundation for developing broader categories and concepts.

c) Constant Comparison

Throughout the analysis, constant comparison was employed to identify similarities and differences within the data, ensuring a thorough examination of emerging categories (Glaser & Strauss, 1967). This iterative process allows for the refinement of categories and the development of a cohesive theoretical framework (Charmaz, 2006).

d) Theoretical Sampling

Theoretical sampling involves collecting additional data to elaborate on emerging categories, guiding further data collection to ensure theoretical saturation (Charmaz, 2006). This method enhances the depth and breadth of the theoretical model.

e) Focussed and Axial Coding and Theoretical Saturation

Focussed coding synthesises initial codes to develop more abstract categories, while axial coding specifies the dimensions of these categories (Strauss & Corbin, 1998). The process continues until theoretical saturation is achieved, meaning no new categories emerge from the data (Charmaz, 2006).

d) Memo Writing

Memo writing is an integral part of grounded theory, providing a record of the researcher's thoughts, comparisons, and theoretical developments throughout the study (Charmaz, 2006). This practice enhances the rigor and coherence of the research process.

e) Ensuring Quality in Research

2.3.5 Owning One's Perspective

Reflexivity is crucial in constructivist grounded theory, requiring the researcher to acknowledge and reflect on their positionality and potential biases throughout the research process (Charmaz, 2006). This involves documenting personal reflections and how they might influence the research findings, thereby enhancing the transparency and credibility of the study (Cope, 2014).

2.3.6 Situating the Sample

Detailed contextual information about the sample is provided to situate the findings within the specific setting of the study (Elliott et al., 1999). This includes demographic information and the context of the NHS inpatient units where the research was conducted.

2.3.7 Grounding in Examples

Grounding the analysis in concrete examples from the data ensures that the emerging theory remains closely tied to the participants' experiences (Charmaz, 2006). This involves using direct quotations and detailed descriptions to illustrate key categories and concepts.

2.3.8 Providing Credibility Checks

Credibility checks, such as member checking and peer debriefing, are employed to enhance the trustworthiness of the findings (Lincoln & Guba, 1985). Member checking involves sharing the findings with participants to verify their accuracy, while peer debriefing involves discussing the analysis with colleagues to ensure its robustness.

2.3.9 Coherence

The coherence of the emerging theory is evaluated by examining how well the categories and concepts fit together to form a comprehensive and logical framework (Strauss & Corbin, 1998). This involves iterative refinement of the theoretical model to ensure internal consistency.

2.3.10 Accomplishing General vs. Specific Research Tasks

Grounded theory aims to balance the generation of specific, context-bound insights with the development of more general theoretical propositions (Charmaz, 2006). This involves identifying the core processes and interactions that are likely to be relevant across different settings, while also acknowledging the specificities of the research context.

2.3.11 Resonating with Readers

Ensuring that the research resonates with readers involves presenting the findings in a way that is accessible and meaningful to practitioners and scholars in the field (Elliott et al., 1999). This includes clear writing, the use of illustrative examples, and a strong narrative structure.

2.4 Ethical Considerations

2.4.1 Obtaining Ethical Approval

Ethical approval

was obtained from the relevant ethics committee, ensuring that the study adhered to ethical guidelines and standards (British Psychological Society, 2014). This included considerations around informed consent, confidentiality, and the welfare of participants.

2.4.1 Researcher/Practitioner Dilemma

The dual role of the researcher as both a practitioner and researcher was carefully managed to avoid conflicts of interest and maintain professional boundaries (Bell & Nutt, 2002). Reflexive practices were employed to navigate potential dilemmas and ensure ethical integrity.

2.4.2 Young Person Safety and Maintaining Confidentiality

The safety and confidentiality of young participants were prioritised throughout the study. Procedures were established to manage any disclosures of risk or distress, and all data were anonymised to protect participants' identities (Shaw, 2003).

2.4.3 Agreeing to Take Part

Participants were provided with clear and accessible information about the study, including its aims, procedures, and potential risks and benefits. Informed consent was obtained from all participants, and for those under 16, parental consent was also secured (Morrow & Richards, 1996).

2.5 Design

2.5.1 Research Context

The research was conducted within two NHS inpatient units providing care for young people with mental health difficulties. Detailed descriptions of these settings are provided to contextualise the findings and ensure transferability (Guba & Lincoln, 1994).

2.5.2 Participants

Participants included young people aged 12–18 who were admitted to the inpatient units for self-harm. A purposive sampling strategy was employed to ensure a diverse range of experiences and perspectives were captured (Patton, 2002).

2.6 Procedure

2.6.1 Interviews

Semi-structured interviews were conducted to gather in-depth data on participants' experiences. The interview guide was designed to be flexible, allowing participants to share their stories in their own words while ensuring that key topics were covered (Willig, 2008).

2.6.2 Interview Procedure

Interviews were conducted in a private setting within the inpatient units, ensuring a safe and confidential environment for participants. Interviews were audio-recorded and transcribed verbatim for analysis.

2.7 Data Analysis

Data analysis followed the principles of grounded theory, involving open coding, axial coding, and selective coding to develop a comprehensive theoretical model. The constant comparative method was used throughout to ensure a rigorous and iterative analysis process (Charmaz, 2006).

The analysis, guided by grounded theory methodology, identified two core concepts: Humanness and Restriction. These concepts encapsulate the essence of the young people's experiences and the factors that shape their perceptions of inpatient care.

3.1 Description of the Young People

The study involved a diverse group of young people aged 12–18, who were admitted to two different NHS inpatient units. These participants varied in terms of their backgrounds, experiences, and the nature and frequency of their self-harm behaviours. This diversity provided a rich dataset from which to develop a comprehensive theoretical model.

3.2 Analysis of Data

3.2.1 The Core Concepts

The analysis revealed two core concepts that are central to understanding the young people's experiences: Humanness and Restriction. These concepts encompass various categories and subcategories that illustrate the complexities of inpatient care from the perspectives of the young people.

Humanness

Humanness refers to the aspects of care that emphasise personal connection, understanding, and empathy. It includes the following subcategories:

Connectedness

Connectedness involves the emotional and relational bonds between young people and staff. Participants highlighted the importance of feeling understood and valued by the healthcare professionals caring for them. Positive interactions were characterised by empathy, active listening, and genuine concern, which contributed to a sense of being cared for as a whole person rather than merely a patient.

Interpersonal Factors

Interpersonal factors encompass the qualities and behaviours of staff that impact the young people's experiences. These include collaboration, staff attributes, and expectations. Effective collaboration between staff and young people was seen as crucial for fostering a supportive environment. Attributes such as patience, kindness, and consistency were particularly valued, while unmet expectations often led to feelings of frustration and disappointment.

Intrapersonal Factors

Intrapersonal factors relate to the young people's internal experiences, such as emotions, hope, and motivation. Participants described a range of emotions, from anxiety and fear to hope and resilience. Being seen and treated as an individual was essential for fostering positive emotional states and encouraging motivation towards recovery.

Restriction

Restriction refers to the elements of inpatient care that impose limits on the young people's autonomy and freedom. This concept includes the following subcategories:

Hospitalisation

Hospitalisation encompasses the process of admission, the environment, and the triggers that exacerbate distress. Many participants found the hospital environment to be both a place of safety and a source of stress, with rigid routines and the presence of other distressed individuals sometimes acting as triggers for self-harm.

Clinical Intervention

Clinical intervention involves the planning of care, techniques, and therapeutic processes used in the inpatient setting. Participants expressed varied experiences with these interventions, with some finding them helpful and others feeling they were insufficiently personalised or ultimately ineffective. The importance of individualised care plans and access to appropriate therapeutic interventions was emphasised.

Dilemma

The dilemma category captures the internal conflicts experienced by the young people regarding control and ambivalence. Many participants felt torn between wanting help and resisting the restrictions imposed by inpatient care. This ambivalence often manifested as a struggle for control over their treatment and environment.

3.4 Bringing It All Together

The core concepts of Humanness and Restriction interact dynamically to shape the overall experience of inpatient care. Positive experiences were often characterised by a balance between these concepts, where the benefits of a supportive and empathetic environment mitigated the feelings of restriction. Conversely, negative experiences were marked by an imbalance, with either excessive restriction or a lack of humanness dominating the young people's perceptions of care.

These findings provided a comprehensive understanding of the factors that influence young people's experiences of inpatient care for self-harm.

Following the grounded theory approach, the findings were considered alongside existing literature and exploring their implications for clinical practice and future research. The core concepts of Humanness and Restriction were examined in depth, highlighting their significance in shaping the experiences of young people in inpatient care who present with self-harm.

4.1 Humanness

The concept of humanness encompasses the personal, empathetic, and relational aspects of care that significantly impact the experiences of young people in inpatient settings. This aligns with existing research that emphasises the importance of empathy, understanding, and individualised care in mental health treatment (Smith-Gowling, Knowles, & Hodge, 2018; Lindgren et al., 2004).

Connectedness

Connectedness, as described by participants, involves the emotional and relational bonds with healthcare providers. This finding supports the work of Schoppmann et al. (2007), who identified the significance of feeling understood and supported by staff. Effective communication and genuine concern from staff members foster a sense of safety and trust, which are critical for positive therapeutic outcomes (Horrocks et al., 2005).

Interpersonal Factors

The qualities and behaviours of staff, such as collaboration, kindness, and consistency, were highlighted as crucial components of positive care experiences. These findings resonate with the literature on therapeutic alliances, which emphasise the role of interpersonal dynamics in effective mental health treatment (Horrocks et al., 2005; Lindgren et al., 2011).

Intrapersonal Factors

Participants' internal experiences, including their emotions and sense of self-worth, were profoundly influenced by the quality of care they received. Being treated as individuals with unique needs and circumstances was essential for fostering hope and motivation. This aligns with the concept of patient-centered care, which advocates for tailoring treatment plans to individual needs and preferences (Taylor et al., 2009; Lindgren et al., 2004).

4.2 Restriction

The concept of restriction highlights the limitations and constraints imposed by the inpatient care environment, which can exacerbate feelings of helplessness and frustration among young people.

Hospitalisation

The dual nature of the hospital environment as both a place of safety and a source of stress was evident in participants' accounts. The rigid routines and exposure to other distressed individuals often acted as triggers for self-harm, underscoring the need for more personalized and flexible care approaches noted by Smith-Gowling, Knowles, and Hodge (2018).

Clinical Intervention

Participants expressed varied experiences with clinical interventions, with some finding them helpful and others feeling they were inadequately personalised. The importance of individualised care plans and access to appropriate therapeutic interventions is well-documented in the literature (Hume & Platt, 2007). These findings suggest a need for more adaptive and patient-specific approaches in clinical settings.

Dilemma

The internal conflicts regarding control and ambivalence experienced by participants reflect the complex nature of self-harm behaviours. These dilemmas often involve a struggle between the desire for help and resistance to the constraints of inpatient care. This aligns with Schoppmann et al. (2007), who emphasised the importance of understanding the underlying reasons for self-harm and addressing them in a supportive and non-judgmental manner.

4.4 The Model of Young Persons’ Experiences of Inpatient Care When Presenting with Self-Harm

The core concepts of Humanness and Restriction interact dynamically to shape the overall experience of inpatient care. A balanced approach that emphasises empathetic, individualised care while minimising unnecessary restrictions is crucial for positive therapeutic outcomes. This model provides a comprehensive framework for understanding and improving the care experiences of young people presenting with self-harm.

The model of young persons’ experiences of inpatient care when presenting with self-harm.

5.1 Strengths and Limitations of the Study

5.1.1 Strengths

One of the primary strengths of this study is its use of grounded theory methodology, which allowed for the development of a theory rooted in the participants' experiences. The qualitative approach provided rich, in-depth insights into the experiences of young people in inpatient care presenting with self-harm, which are often overlooked in quantitative studies. Additionally, the use of semi-structured interviews facilitated a comprehensive exploration of participants' perspectives, a practice that is likely to have enhanced the study's depth and validity (Charmaz, 2006).

5.1.2 Limitations

Despite its strengths, the study has several limitations. The sample size, although adequate for qualitative research, was relatively small and limited to two NHS inpatient units. This may restrict the generalisability of the findings to other settings or populations. Furthermore, the reliance on self-reported data could introduce biases, such as social desirability bias, where participants may provide responses they believe are expected by the researcher (Patton, 2002). The study's cross-sectional design also limits the ability to draw conclusions about changes in experiences over time.

5.2 Assessing the Quality of the Research Study

5.2.1 Reflexivity/Owning One’s Perspective

Throughout the research process, reflexivity was maintained to acknowledge and address the researcher's potential biases and influence on the data collection and analysis (Cope, 2014). This involved continuous reflection on the researcher's positionality and its impact on the study.

5.2.2 Situating the Sample

Providing detailed contextual information about the sample and research setting ensured that the findings were situated within their specific context, enhancing the study's credibility and transferability (Elliott et al., 1999).

5.2.3 Grounding in Examples

Grounding the analysis in concrete examples from the data ensured that the emerging theory remained closely tied to the participants' experiences (Charmaz, 2006). This involved using direct quotations and detailed descriptions to illustrate key categories and concepts.

5.2.4 Providing Credibility Checks

Credibility checks, such as member checking and peer debriefing, were employed to enhance the trustworthiness of the findings (Lincoln & Guba, 1985). These processes helped ensure that the findings accurately reflected the participants' experiences and were robust.

5.2.5 Coherence

The coherence of the emerging theory was evaluated by examining how well the categories and concepts fit together to form a comprehensive and logical framework (Strauss & Corbin, 1998). This iterative process involved refining the theoretical model to ensure internal consistency.

5.2.6 Accomplishing General vs. Specific Research Tasks

The study balanced the generation of specific, context-bound insights with the development of more general theoretical propositions. This involved identifying core processes and interactions relevant across different settings while acknowledging the specificities of the research context (Charmaz, 2006).

5.2.7 Resonating with the Reader

Ensuring that the research resonated with readers involved presenting the findings in a way that was accessible and meaningful to practitioners and scholars in the field (Elliott et al., 1999. This included clear writing, illustrative examples, and a strong narrative structure).

5.3 Implications of the Current Study

5.3.1 Improving Understanding

The findings underscore the importance of understanding the personal and relational aspects of care from the perspectives of young people. Enhancing empathy, communication, and individualised care can significantly improve the inpatient experience for young people presenting with self-harm (Smith-Gowling, Knowles, & Hodge, 2018).

5.3.2 Improving and Maintaining Relationships

Fostering positive relationships between staff and young people is crucial for effective care (Horrocks et al., 2005). Training programs that emphasise interpersonal skills and empathy can help staff build stronger, more supportive relationships with young patients.

5.3.3 Connection

Maintaining a sense of connection between young people and their support networks is essential. This can be achieved by involving family members in the care process and ensuring regular, meaningful contact with trusted individuals (Lindgren et al., 2004).

5.3.4 Collaborative Development of Individualised Care Plans

Developing individualised care plans in collaboration with young people ensures that their specific needs and preferences are addressed. This collaborative approach can enhance engagement and adherence to treatment (Taylor et al., 2009).

5.3.5 Ensuring Access to Talking Therapies

Providing access to evidence-based talking therapies, such as Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT), is essential for addressing the underlying issues related to self-harm and promoting recovery (Miller, Rathus & Linehan, 2007).

5.3.6 The Inpatient Environment

Creating a therapeutic and supportive inpatient environment that minimises stressors and enhances safety is critical. This may include addressing environmental factors that may act as triggers for self-harm and promoting a sense of normalcy and comfort (Smith-Gowling, Knowles, & Hodge, 2018).

5.3.7 Developing Community Services

Strengthening community-based services to provide ongoing support after discharge is vital for preventing relapse and ensuring continuity of care. This includes offering accessible and flexible services that can address the diverse needs of young people (DoH, 2017).

5.4 Recommendations for further research

Future research should explore the experiences of young people in a broader range of inpatient settings to enhance the generalisability of the findings. Longitudinal studies could provide valuable insights into how experiences and outcomes evolve over time. Additionally, research should investigate the effectiveness of specific interventions and care models in improving the inpatient experience for young people presenting with self-harm.

This study provided a comprehensive exploration of young people's experiences of inpatient care when presenting with self-harm, highlighting the core concepts of Humanness and Restriction. The findings emphasise the importance of empathetic, individualised care and the need to address the constraints of the inpatient environment. By improving understanding, fostering positive relationships, and developing personalised care plans, healthcare providers can enhance the therapeutic experience for young people. The study's insights contribute to the development of effective treatment guidelines, policy development, and service planning, ultimately improving the quality of care for young people who present with self-harm in inpatient settings.

Generative AI and AI-assisted technologies in the writing process

During the preparation of this work the author used Chat GPT in order to improve editing of the manuscript. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the content of the publication.

Ethical Approval

Relevant ethical approval was obtained the NHS ethics and the University of ethics panel in accordance with the required processes.

Informed consent

was obtained for both research and publication from all participants and authors.

Funding

Not applicable.

Author Contribution

F.P. wrote the main manuscript and completed the research and P.M. supervised the project

Acknowledgement

I wish to acknowledge my supervisor Professor Peter Martin as well as clinical supervisor Dr Sophie Browning

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No competing interests reported.

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Young persons’ experiences of inpatient care when presenting with self-harm

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Abstract

Figures

1. Introduction

2. Methodology

2.1 Philosophy of the Approach

2.2 Why Use a Qualitative Approach?

2.3 Grounded Theory

2.3.1 Introduction to Grounded Theory

2.3.2 How Grounded Theory is Used in This Study

2.3.3 The Motivation to Use Grounded Theory

2.3.4 The Implementation of Grounded Theory

2.3.5 Owning One's Perspective

2.3.6 Situating the Sample

2.3.7 Grounding in Examples

2.3.8 Providing Credibility Checks

2.3.9 Coherence

2.3.10 Accomplishing General vs. Specific Research Tasks

2.3.11 Resonating with Readers

2.4 Ethical Considerations

2.4.1 Obtaining Ethical Approval

2.4.1 Researcher/Practitioner Dilemma

2.4.2 Young Person Safety and Maintaining Confidentiality

2.4.3 Agreeing to Take Part

2.5 Design

2.5.1 Research Context

2.5.2 Participants

2.6 Procedure

2.6.1 Interviews

2.6.2 Interview Procedure

2.7 Data Analysis

3. Findings

3.1 Description of the Young People

3.2 Analysis of Data

3.2.1 The Core Concepts

3.4 Bringing It All Together

4. Discussion

4.1 Humanness

4.2 Restriction

4.4 The Model of Young Persons’ Experiences of Inpatient Care When Presenting with Self-Harm

5. Limitations of Study, Implications of the Findings, Recommendations for Further Research, Summary, and Conclusion

5.1 Strengths and Limitations of the Study

5.1.1 Strengths

5.1.2 Limitations

5.2 Assessing the Quality of the Research Study

5.2.1 Reflexivity/Owning One’s Perspective

5.2.2 Situating the Sample

5.2.3 Grounding in Examples

5.2.4 Providing Credibility Checks

5.2.5 Coherence

5.2.6 Accomplishing General vs. Specific Research Tasks

5.2.7 Resonating with the Reader

5.3 Implications of the Current Study

5.3.1 Improving Understanding

5.3.2 Improving and Maintaining Relationships

5.3.3 Connection

5.3.4 Collaborative Development of Individualised Care Plans

5.3.5 Ensuring Access to Talking Therapies

5.3.6 The Inpatient Environment

5.3.7 Developing Community Services

5.4 Recommendations for further research

6. Summary and Conclusion

Declarations

Funding

Author Contribution

Acknowledgement

References

Additional Declarations

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